Diagnosis and Prognosis for Leiomyosarcoma

Surgical biopsy is necessary to determine whether a soft tissue tumor is malignant or benign and to establish the prognosis for leiomyosarcoma. A biopsy generally involves making a small incision and inserting a special needle to remove a sample of the tumor tissue. When uterine leiomyosarcoma is suspected, a small piece of affected smooth muscle tissue is biopsied from inside the uterus.

A pathologist (a doctor who specializes in medical diagnosis) will examine the biopsy sample under a microscope to determine the presence, type and grade of cancer. These factors combined determine the prognosis for leiomyosarcoma. Unlike many other types of cancer, the size of the tumor is not as important for the prognosis of leiomyosarcoma as is the appearance of the cancer cells under the microscope.

Cell Characteristics Determine Prognosis for Leiomyosarcoma

What is Spindle Cell Sarcoma?Spindle cell sarcoma is a cancerous tumor of the smooth muscle, where the cells are elongated, resembling a spindle. The description spindle cell sarcoma is often used as a generic term for smooth muscle tumors such as leiomyosarcoma. Spindle cell sarcoma, however, is also used to describe two other types of tumors: malignant fibrous histiocytoma and fibrosarcoma, both of which are soft tissue sarcomas that occur in fibrous tissues throughout the body.

Cell type and shape: The pathologist will look for spindle cells (with “cigar-shaped” nuclei). These spindle cells are characteristic of smooth muscle tumors, also called spindle cell sarcoma.

Atypia: The presence of atypical looking spindle cells, different from the normal spindle cells, generally indicates a more advanced stage of spindle cell sarcoma and poorer prognosis for leiomyosarcoma.

Mitotic activity: Mitosis is the process by which cells divide and reproduce. Counting the number of mitotic cell divisions in a biopsy is a useful indicator of the aggressive nature of the spindle cell sarcoma
and the prognosis for leiomyosarcoma.

Necrosis: The presence of dead tissue in and around the tumor, known in the medical field as necrosis, indicates a poor prognosis for leiomyo-sarcoma.

Stages and Prognosis for Leiomyosarcoma

The prognosis for leiomyosarcoma is largely dependent upon the grade, stage and spread of the cancer as determined by biopsy. Age and general health are also important factors in determining a patient’s prognosis for leiomyosarcoma.

Once soft tissue sarcoma is diagnosed, additional tests called staging are performed to determine spread (metastasis), prognosis for leiomyosarcoma, and an appropriate treatment strategy.

Stage IA: Spindle cell sarcoma near surface; diameter is less than 5 cm; has not spread; cells resemble or differ slightly from normal cells.Stage IB: Spindle cell sarcoma near surface; larger than 5 cm; has not spread; cells resemble or differ slightly from normal cells.Stage IIA: Spindle cell sarcoma deeper in the tissue; larger than 5 cm; cells resemble or differ slightly from normal cells.Stage IIB: The spindle cell sarcoma either near surface or deeper in the tissue; larger than 5 cm; has not spread; cells differ from normal cells.Stage IIC: Spindle cell sarcoma near surface; larger than 5 cm; has not spread; cells differ significantly from normal cells.Stage III: Spindle cell sarcoma deeper in the tissue; has not spread;
larger than 5 cm; differ significantly from normal cells; prognosis is poor.Stage IV: Spindle cell sarcoma has spread; prognosis is extremely poor.